Wednesday, October 14, 2015

I have checked my blog statistics and the most popular post of all time, with almost 2.5 thousand views is about the brain hat.

The printouts and instructions on making an this pretty cool brain hat can be found here.

I' like to add that the website belongs to Ellen Johnston McHenry, who is a home-school curriculum author. Among others, she published The Brain: An introduction to neurology for ages 8-14
- a very nice, comprehensive book that starts from zero and ends
somewhere at the early undergraduate level while explaining everything
gently. I've bought it and had a quick look and so far it looks excellent.

Worth having a look if you have a kiddie that is interested in what you do (here)!

I have checked PARiConnect privacy provisions and they appear adequate for my purposes. It is is HIPAA compliant (not that it matters for us in Australia) and states that it never accesses, mines or analyzes client data. There is encryption and no third party providers. However, I'd recommend that you check this for yourself so that you are in compliance with your ethical requirements.

I have now used PARiConnect to administer BRIEF to clients: both self assessment and parent assessment form. The assessment was very easy to use and had some validity screening built in (apart from the BRIEF-native validity scales, it also checked that all the questions were answered, provided the time the client took to fill in the form and how it compared to a typical administration time, and showed the clinician raw results to check for any unusual patterns).

I have also checked the pricing:
- TOGRA administrations are $2.50 each, with additional $2.50 for a report (sold with a minimum of 5)
- BRIEF administrations are $3.50 with $2.00 for scoring report or $6.00 fort interpretative report (also sold with a minimum of 5).

The prices are quite good: in comparison PAA's packet of 25 parent BRIEF questionnaires costs $121.00, which gives it a price of $4.84 per form, even before the shipping costs. I remember checking this a while ago and thinking that the electronic administration was very expensive - so either it has changed or I'm seeing US prices. However, the prices listed on the website (pariconnect.com) are the same prices I'm seeing when I go to buy tests, so the worst I'd expect is that I'd be paying these in US dollars.

Monday, October 12, 2015

I have used one of my free administrations on PARiConnect to check out TOGRA.

TOGRA is a screen of reasoning and problem solving skills for ages 10 - 75, meant to minimize racial, gender and religious (?) bias. The website says that it was standardized on a 2010-Census-matched sample of 3,013 individuals, so the normative sample is very nice, as is the age range. There are two equivalent forms.

It is a timed, 16-minute multiple choice test. It is meant to measure verbal, nonverbal, and quantitative reasoning and the problems consist of: matrices, vocabulary (e.g.: which word does not belong, which word is the opposite of), and numerical patterns and equations (with relatively little working memory loading, as the client is allowed pen and paper). It is supposed to be supervised, so that the client does not use a calculator or internet.

This is very much an assessment of reasoning, without speed of processing or working memory components. However, it looks like a very solid IQ screen, an excellent component of any computerised battery, or a way of quickly establishing GAI when focusing on a specific assessment issue.

I have finally investigated PARiConnect. This is another online platform for test administration, with some interesting neuropsychological tools (for example TOGRA looks really good for some clinical uses).

I needed a child version of BRIEF it for tomorrow, so I called PAR (Australian number 1800 101 607 - finding that out was the hardest part of the job) and asked to get onto PARiConnect to use their electronic administration.

I'm very impressed with the ease and speed of organising the whole thing - the customer support walked me through a very short and sweet set-up, and I was told that I have three free tests and reports to use. Yey!

The administration is online and one can use a computer or tablet to do it.

I still need to read their privacy policy in excruciating detail, considering that client data will be kept online, but otherwise I am good to go. By the way, my current policy is to only record clients initials with any online administrations. Any other systems out there?

Apps for detection of epilepsy:
- Epdetect is an iPhone app that uses motion sensors to detect seizures.
- Smartmonitor's Smartwatch that transmits information about the seizure and the location of the patient to a pre-determined contact
- Affectiva's Q Sensor that uses galvanic skin response rather than movement to detect seizures, and to record their severity

Monday, June 29, 2015

I wrote a while back on Active Memory, a new brain training program
developed in the Florey Institute in Melbourne. I have since received an
email from MaryCastellani,
a post-graduate student at LaTrobe. She points out that there is no
published research on this product as yet, and no substantial
information about it on the Florey or Uni of Melbourne websites. The website indicates that users “Contribute to Research”, with
University of Melbourne and Florey Institute logos embedded within the
website. .

Mary
has also included some links to interviews with Prof Wood, who created
the program, and I thought they may be worth re-posting for those who
are interested in what is happening in Melbourne's neuroscience:

My apologies for the long silence. Life and family issues are taking my time at the moment.

We have been talking about finger tapping tests, such as DigiTap app a while ago, and I asked if anybody is using them. I have since had email from a colleague who says he uses it regularly, particularly when wanting to examine motor slowing or needing an indicator of a subtle weakness on one side. He uses norms from Spreen and Strauss, which he finds not to be ideal, but better than nothing. He feels that when using an iPad app people tends to get somewhat inflated scores, and tends to take notice only when both fingers are well below expectation (e.g. >1.5 SD), or if there is a big difference between fingers. Sounds to me like a good clinical rule of thumb.

Wednesday, April 8, 2015

With thanks to Les Posen who forwarded this article from the Pulse magazine.

The article describes an about-to-launch Australian tele-health app, which you can use to store your medical history to and access your GP remotely, including full video-conference visits. A very elegant app, which enables forwarding of data such as blood sugar, blood pressure, prescriptions, etc. The platform will be free to use, with only the 'GP visits' being charged. We probably don't need most of its features, but I wonder if we could adapt it for the purposes of remote counseling and consulting.

As with everything these days, there are quite a few apps out there for those with Parkinson's Disease. Some of them are more interesting than others.

For example, Parkinson's Speech Aid helps the client to reduce the rate of speaking and makes talking easier. It uses the 'choral speech effect' that enables those with Parkinson's Disease (or stuttering - for a good video have a look here) to speak fluently. A good website discussing choral speech effect in PD can be found here.
If you followed the links, you gathered that the speech is improved by providing the client with a delayed 'echo' of their own speech. Clients usually carry a tiny device in their ear to provide them with the auditory trace. The app on the phone is designed to let those with Parkinson's Disease experiment with the effect and ultimately decide if they want to invest in the in-ear gizmo. A similar app, with the capacity to adjust a few parameters is DAF Assistant.

LiftPulse app is an app that records longitudinal data on hand tremor using the phone's accelerometer. Another one of these apps is TR_Meter.

Yet another interesting new app is the Parkinson mPower app, which is designed to let clients track their disease and contribute data to a longitudinal study on disease progression. Only available in the US for now. According to Apple:

The app will measure
dexterity, balance and gait, voice, and memory at multiple times each
day. For example, patients will use the app to record their
voice. Subtle changes to the voice, including tremor and reduced
amplitude have been shown to be an accurate way to measure the severity
of symptoms. The app will can also measure dexterity by tracking how
fast a person can tap the screen on their iPhone. The device’s GPS and
accelerometer can measure mobility and balance. '

The last app is DigiTap, which is a finger-tapping test translated into the electronic format. There are a few useful features, such as a timer that only starts with the fist tap and prevents recording new taps after the time elapses. Alas, neither the app nor the website carries any suggestion that normative data is available. Is there any neuropsychologists in Australia that still use the finger tapping? If so, could you let us know in the comments what you think about the electronic alternatives?

These apps have an important thing in common - they fully use the capacity of their electronic platform. This is one thing that is lacking in most-computer-based neuropsychological tests. Most of them may as well be paper and pencil. Can we do better?

The brains are made using a brain jelly mold (plenty of places this can be bought on the internet).

This one is a kitchen utensil no neuropsychologist should be without. Particularly good with off-white jellies, such as almond pudding. You could also consider putting some frozen strawberries inside to simulate a tasty bleed.

Monday, March 23, 2015

What do Oliver Sacks and Carl Kruszelnicki have in common? Developmental prosopagnosia - both of them admit to marked difficulty in recognizing faces.

I've recently had a look into the issue of remediation of prosopagnosia and while it appears that acquired prosopagnosia is difficult to treat, developmental prosopagnosia is much easier to remedy. There is interesting article in on-line Brain:

DeGutis, J., Cohan S., Ken Nakayama, Ken (2014). Holistic face training enhances face processing in developmental prosopagnosia. Brain.
Prosopagnosia has largely been regarded as an untreatable disorder.
However, recent case studies using cognitive training have shown that it
is possible to enhance face recognition abilities in individuals with
developmental prosopagnosia. Our goal was to determine if this approach
could be effective in a larger population of developmental
prosopagnosics. We trained 24 developmental prosopagnosics using a
3-week online face-training program targeting holistic face processing.
Twelve subjects with developmental prosopagnosia were assessed before
and after training, and the other 12 were assessed before and after a
waiting period, they then performed the training, and were then assessed
again. The assessments included measures of front-view face
discrimination, face discrimination with view-point changes, measures of
holistic face processing, and a 5-day diary to quantify potential
real-world improvements. Compared with the waiting period, developmental
prosopagnosics showed moderate but significant overall training-related
improvements on measures of front-view face discrimination. Those who
reached the more difficult levels of training (‘better’ trainees) showed
the strongest improvements in front-view face discrimination and showed
significantly increased holistic face processing to the point of being
similar to that of unimpaired control subjects. Despite challenges in
characterizing developmental prosopagnosics’ everyday face recognition
and potential biases in self-report, results also showed modest but
consistent self-reported diary improvements. In summary, we demonstrate
that by using cognitive training that targets holistic processing, it is
possible to enhance face perception across a group of developmental
prosopagnosics and further suggest that those who improved the most on
the training task received the greatest benefits.

1. FaceSay - which retrains face recognition, emotion recognition and following gaze - aimed at helping autistic kids (has some research proving that it improves behaviour in the playground)
2. A subtest of BrainHQ called Recognition that could be used for training for adults and potentially non-autistic children.

- I've just discovered that I had over 1000 page views last month. Well, well.

- I'm looking forward to a review of a virtual reality tool for testing attention in children promised by a lovely neuropsychologist from Sydney -stay tuned

- I am playing with the Vienna Test System which has got a gorgeous suite of tests of various aspects of attention and other goodies. There are some technical difficulties, but I am getting through them, and as soon as I've played enough I'll publish a review.

- I am also planning to review MicroCog suggested by Arthur Shores, but need to research it first. Is there anybody routinely using it that would be willing to write a review?

- I've decided to start publishing news about brain training again. There are too many interesting things happening in that area. For example, Melbourne's Florey Institute, University of Melbourne and the ABC have issued a new brain training program aimed at the elderly: ABC Active Memory. It is fairly widely advertised, and we should expect our older clients to have tried it. We need to be aware that it uses both a modified form of STROOP and Trail Making Test. I think that soon the Trail Making Test will become useless for purposes of assessment. Having said that, the tasks in the ABC Active Memory are rather cleverly constructed and worth a look. For example, the highest level of Trail Making Test has letters, numbers and dots on dice.

Friday, March 6, 2015

Prof Arthur Shores alerted me to two computerized tools that he believes are under utilised in Australia. One of them is MAB II. I have to admit that while the name rings some distant bells, I have not looked at this test before.

And I should have.

This test is incredibly similar to the WAIS, with the following subtests:

It is for adults 16+ and has a multiple choice response format. It has been used by the NASA and in selection of pilots, as well as in research.

It computes VIQ, PIQ and FSIQ and can be administered individually, in groups or on a computer. It appears to be an analogue to WAIS-R, with no separate WMI and PRI indexes, but it seems to do what it does quite well:

The normative group consisted of 1600 subjects (2200 for WAIS-IV), in 9 age groups (13 for WAIS-IV)

Test-retest reliability is .95 for VIQ, .96 for PIQ and .97 for FSIQ

For WAIS-IV it is .95 for VCI, .85 for PRI and .95 for FSIQ

Internal consistency is .87, while WAIS has internal consistencies in the .90s, so it scores somewhat worse there.

What I really wanted to know is how close it is to WAIS, but haven't found it on the internet apart from the statement from the test creators that said:

Correlations between the MAB II and a widely used individual IQ measure are:

Full Scale = .91

Performance correlation = .79

Verbal correlation = .94

I have a sneaking suspicion that they refer to WAIS-R, but cannot be sure.

I also want to know how I managed not to know that there is a reasonable computerised IQ test around. Shame on me.

I'm sure that this test won't work in all situations, and that we'll naturally default to WAIS for most of our clinical needs. But I believe that there are assessments that can be done using MAB II instead. I would argue, for example, that it beats short forms of the WAIS.

Arthur sent me several articles in which MAB II has been used, together with MicroCog (this one is for another post) to track some relatively subtle cognitive changes. This seems like a good test.

I have not (yet!) bought it, so cannot comment on the ease of use. Do people use it? How smooth is it? What populations do you use it with? Please let us know in the comments

Friday, February 27, 2015

I have recently read a thorough review of computerized testing in dementia by one of our colleagues: Nicola Gates.

Gates, N.J., Kochan, N.A. (2015). Computerized and on-line neuropsychological testing for late-life cognition and neurocognitive disorders: are we there yet? www.co-psychiatry.com, Vol 28 (2), which you can access (for a price, alas) at http://journals.lww.com/co-psychiatry/Abstract/2015/03000/Computerized_and_on_line_neuropsychological.15.aspx

It is a must-read for all of us who work in dementia, even though her conclusions are pretty much negative. It seems that there are no good tools in this area yet. Some are adapted from the military or sports psychology and don't do what we need them to do in dementia assessments. Others are computerised versions of paper-and-pencil tests, which are not comparable to the original tests, and which do not have new normative data. And, of course, the elderly, especially those with a dementing illness, are the one client group that is really the worst suited to computerised assessment: some of them have never used computers, others are wary of them, and yet others have motor and sensory problems that affect testing.

There were some tests that received reasonable billing in the article, and I reviewed them for this post. These were:

This test is billed as 'neuropsychological testing administered by a computer with qualified health care professional interpretation and report'. There are 3 versions available in the app store, costing $3.79, $12.99, and $64.99, but it is not clear what the difference is between each version. After a short search I think that the difference is in the quality of output information. The test itself is a replacement for the Mini-Mental and includes: memory for 3 words, orientation questions, naming and remembering 12 common objects (called 'sequential memory' for some reason) and clock drawing. It claims 85-89% sensitivity and 76-87% specificity in screening dementia, outperforming both MMSE and Mini-Cog. So this is a nice tool, it is just pretty useless to us, being a pretty basic screening tool. Pity.

- Cognitive Assessment for Dementia (CADi) on the iPad that has large concurrent validity with the Mini-Mental and good internal consistency

This one sounded good, so I tried to download and and test it, but found only a Japanese language version in the app store. Hoping that an English version exists, I downloaded it, but had no luck. I think the authors were Japanese, and I am not sure if an English version of this test exists.

- Self-administered Cognitive Function Test (CFT) which showed good concurrent validity with paper-and-pencil tests in correlational analysis. However, there was no information on test-retest reliability, which Nicola notes is a problem in a test that is supposed to be used for self-monitoring over time.

This one can be accessed on http://cft.foodforthebrain.org/. I dutifully went through it, and was declared unlikely to have dementia. It consists of a good task of visual memory and quite clever analogues to Symbol Search and Coding. Also, it has a pre-test screen that checks facility with the use of a computer (one has to mouse-click on some targets as fast as one can). While it is a nice example of a good computerised test, it is not going to be in any way useful for our practice.

So, as to computerised tests and the elderly, we are not there yet.

The only computerised test that I do use in this group is the iPad-based Mini-Mental from the PAR (handy if you want to be meticulous with copyright compliance), but I cannot say that it is particularly good either.

I think that computerised testing of adults and children is a much better proposition, but I'll write about it this in other posts.

Wednesday, January 28, 2015

I have been looking at computerized neuropsychological tests lately. For three very important reasons:

Computers do a much better job of administering some tests, e.g. those of speed of processing and attention. I think that our insistence on human-administered tests may mean that we use substandard tools for some jobs.

I think that neuropsychologists need to start using computerised tests a lot more - our expertise is in test interpretation, and we don't have to personally administer each and every test that we interpret - it is not the most efficient use of our time, and

I am booooored - how many times a week can you do the same thing (admittedly in different clinical context, but still)?

I'll get into the tests I have used or still use on another occasion, but today I want to share a new set of tests I've just discovered. They focus on learning difficulties and are produced by a British company - Lucid Research (http://www.lucid-research.com).

For example, there is a fully computerized working memory test (named Recall), normed on over 1000 kids aged 7-16 years (though while most age groups are around 100 kids, there are only 21 kids in the 16 - 16:11 group). The program tests verbal short term memory, visual short term memory and working memory (a task of which has both visual and verbal content, but is probably more verbal in nature). Simple, but definitively worth a look.

They also have a selection of tests screening for cognitive issues that may cause reading problems. For example Rapid screen looks at phonological processing, short-term auditory memory (they name it working memory, but it isn't really), phonic decoding skills and visual-verbal integration memory. All this in 15 minutes of testing without intense input from the administrator. Nice.

While Rapid is a quick screener, there are also in-depth diagnostic tests of reading difficulties. For example LASS 8-11 (yes, LASS, there is also LADS - quite British, this) has verbal span, visual span, reading words, nonwords and sentences, phonological processing, spelling and a quick general ability screen. A nice little test to add to the battery for those of us who deal with learning difficulties.

Has anybody used the tests and could provide their experience and impression in the comments?

Thursday, January 15, 2015

I started the year with a lot of admin and now have a pack of new assessments that need to be written up. So for light relief I went searching for brain-related t-shirts.

I've checked http://www.zazzle.com/, which used to have some nice ones and have been most impressed by how their collection has expanded. From brain images, MRI scans and chemical structure of neurotransmitters to t-shirts with slogans such as 'Area 25 made me do it'.

There is also a wide selection of t-shirts for our clients, including such beauties as: 'Concussions will mess with your head', 'Not today, darling, I had a craniotomy', or 'I have chemobrain, what is your excuse?'. Also and iPhone cover that says 'Keep calm and listen to the neuropsychologist'. I'd get a few if I was doing neuropsych rehabilitation.

Sadly, there is also a selection of t-shirts and gadgets with Stroop test.

I'm contemplating buying a t-shirt with 'I can't brain today, I have the dumb' that is just perfect for some days. And a mug with 'Trust me, I am a neuropsychologist' to use at work.

cheers,

Izabela

PS: I am building up to some serious posts on computerised assessment tools. I'd appreciate guest posts from people who use them in their practice.